ASCO’s Quality Oncology Practice Initiative (QOPI), an oncology-led, quality assessment and improvement program, measured family history taking and genetic counseling/testing practices among 750 community oncology practices. Results of this study revealed gaps that need to be addressed in making sure the taking of family history is accurate and patients whose cancers may have a heritable component get referred for genetic counseling and testing. In general, among community practices, higher rates of family history taking were observed than for appropriate genetic counseling and testing. The study was confined to patients with breast cancer and colorectal cancer.
“An accurate family history and appropriate referral for genetic testing has important implications for the treatment and follow-up of patients, as well as for their family members,” said lead author Marie Wood, MD, professor of medicine and director of the Familial Cancer Program at the University of Vermont in Burlington. “We found that community oncologists were better at documenting family history information than we assumed, but there is room for improvement.”
The study included 212 community oncology practices and 10,466 patients’ charts. More than three-quarters (77%) of charts included first-degree family histories of cancer, and 62% documented second-degree cancer histories as well. However, less than half of charts documented the age at diagnosis for all relatives with cancer.
Twenty-two percent of all patients were referred for genetic counseling or testing. Of patients with guidelinedefined hereditary risk, 52% of breast cancer and 26% of colorectal cancer patients were referred for genetic counseling or testing. When genetic testing was performed by the practice, consent was documented in 78% and discussion of results was documented in 79%.
The authors stated that significant developments are needed to improve identification and management of patients at high risk who should be counseled and tested. Education is an important component to address this problem.
Reference
Wood M, Kadlubek P, Lu KH, et al. Quality of cancer family history and referral for genetic counseling and testing among oncology practices: a pilot test of quality measures as part of the ASCO Quality Oncology Practice Initiative (QOPI). Presented at: 2012 Annual Meeting of the American Society of Clinical Oncology; June 2012; Chicago, IL. Abstract CRA1505.
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